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General NPI Number Information
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NPI Number | 1497911697
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Entity Type | Individual
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Provider Name | JANE BRADLAW D.O.
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Gender | Female
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Dates
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Enumeration Date | 08/06/2008
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Last Update Date | 10/13/2025
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Provider Practice Location Address
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Address Line | 2000 ROOSEVELT RD DEPARTMENT OF EMERGENCY MEDICINE
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City | VALPARAISO
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State | IN
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Zip | 46383-2800
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Country | US
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Telephone | 219-477-5242
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Fax | 219-477-4859
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Provider Business Mailing Address
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Address Line | PO BOX 6755
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City | SAN DIEGO
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State | CA
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Zip | 92166-0755
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 20A18845
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 02003905B
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License Number State | IN
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